Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis
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Targeted therapy or chemotherapy is suggested as standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 1–2 according to the Barcelona Clinic Liver Cancer (BCLC) system. The underlying rationales have not been fully studied.
This study enrolled 2,620 HCC patients. One-to-one matched pairs between HCC patients receiving aggressive anti-HCC treatments (resection, transplantation, ablation, and transarterial chemoembolization) and those receiving targeted therapy or chemotherapy or best supportive care were generated by using the propensity score with a matching model. Survival analysis was performed with the Kaplan–Meier method and the log-rank test. Mortality risk was calculated with the Cox proportional hazards model.
Of 793 patients with PS 1–2, 64 % received aggressive anti-HCC treatments against the suggestion of the BCLC system. The patients receiving aggressive anti-HCC treatments had significantly milder cirrhosis, a smaller tumor burden, and better long-term survival than the patients undergoing targeted therapy or chemotherapy or best supportive care (all p < 0.05). With the use of propensity scores, 166 pairs of matched HCC patients with PS 1–2 were selected from different treatment groups. After matching, patients were comparable in age, gender, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all p > 0.05) at baseline. In the propensity score model, patients with PS 1–2 undergoing aggressive anti-HCC treatments had significantly better long-term survival (p < 0.0001). The adjusted hazard ratio of the choice for targeted therapy or chemotherapy or best supportive care to the choice for aggressive anti-HCC treatments was 2.028 (p < 0.0001).
According to the findings, HCC patients with PS 1–2 should consider aggressive anticancer treatments if no contraindication is noted. Adjustment of the BCLC treatment allocation is needed to enhance its prognostic accuracy.
KeywordsSorafenib Propensity Score Tace Supportive Care Barcelona Clinic Liver Cancer
This study was supported by Grants from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007) in Taiwan, from the Taipei Veterans General Hospital (V103C-008) in Taipei, Taiwan, and from the Ministry of Education, Aiming for the Top University Plan (103AC-P618) in Taiwan.
- 3.Dufour JF, Bargellini I, De Maria N, et al. Intermediate hepatocellular carcinoma: current treatments and future perspectives. Ann Oncol. 2013;24(Suppl 2):ii24–9.Google Scholar
- 5.EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.Google Scholar
- 7.Hsu CY, Lee YH, Liu PH, et al. Decrypting cryptogenic hepatocellular carcinoma: clinical manifestations, prognostic factors and long-term survival by propensity score model. PLoS One. 2014;9:e89373.Google Scholar
- 14.Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: a simulation study. Stat Methods Med Res. 2014 (in press).Google Scholar
- 20.Kim BK, Kim SU, Park JY, et al. Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single-centre experience from long-term clinical outcomes of 1,717 treatment-naive patients with hepatocellular carcinoma. Liver Int. 2012;32:1120–7.CrossRefPubMedGoogle Scholar
- 21.Kim BH, Park JW, Nam BH, et al. Validation of a model to estimate survival in ambulatory patients with hepatocellular carcinoma: a single-centre cohort study. Liver Int. 2014 (in press).Google Scholar
- 25.Yau T, Tang VY, Yao TJ, et al. Development of Hong Kong Liver cancer staging system with treatment stratification for patients with Hepatocellular Carcinoma. Gastroenterology. 2014 (in press).Google Scholar